20130014 Ver 1_401 Application_20130113

20 1 300 1 4
of warF —
a 90� Office Use Only-
Corps action ID no
DWQ project no
Form Version 1.4 January 2009
Pre - Construction Notification (PCN) Form
A. Applicant Information
1. Processing
1a. Type(s) of approval sought from the Corps..
® Section 404 Permit ❑Section 10 Permit
1b. Specify Nationwide Permit (NWP) number: 14 or General Permit (GP) number:
1c. Has the NWP or GP number been verified by the Corps?
❑ Yes ® No
1d. Type(s) of approval sought from the DWQ (check all that apply):
® 401 Water Quality Certification – Regular ❑ Non -404 Jurisdictional General Permit
❑ 401 Water Quality Certification – Express ❑ Riparian Buffer Authorization
le. Is this notification solely for the record
because written approval is not required?
For the record only for DWQ
401 Certification:
© Yes ❑ No
For the record only for Corps Permit:
Yes ❑ No
1f. Is payment into a mitigation bank or in -lieu fee program proposed for
mitigation of impacts? If so, attach the acceptance letter from mitigation bank
or in -lieu fee program.
[] Yes ® No
1g below. located in any of NC's twenty coastal counties. If yes, answer 1h
❑Yes No
1h. Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes © No
2. Project Information
2a. Name of project:
Ace /Avant
2b. County:
Randolph
2c. Nearest municipality / town:
Randleman
2d. Subdivision name:
N/A
2e. NCDOT only, T.I.P. or state project no:
N/A
3. Owner information
3a. Name(s) on Recorded Deed:
Ace /Avant Real Property Company, LLC
--
3b. Deed Book and Page No.
3c. Responsible Party (for LLC if
applicable):
1988/1185
T
racy Matson
'
3d. Street address:
109 Seminole Drive OEM - WATER 01 A
Archdale, NC 27263
3e City, state, zip.
3f. Telephone no.:
336 -431 -5852
3g. Fax no.:
336 -431 -0081
3h. Email address:
tmatson @aceavant.com or msomemero @aceavant.com
Page 1 of 10
PCN Form – Version 1.4 January 2009

4. Applicant Information (if different from owner)
4a. Applicant is:
❑ Agent Q Other, specify:
4b. Name:
Tracy Matson
4c. Business name
(if applicable):
Ace /Avant Real Property Company, LLC
4d. Street address:
109 Seminole Drive
4e City, state, zip.
Archdale, NC 27263
4f. Telephone no.:
336- 431 -5852
4g. Fax no.:
336 -431 -0081
4h. Email address:
tmatson @aceavant.com or msomero @aceavant.com
5. Agent/Consultant Information (if applicable)
5a. Name:
H. Mack Summey, Jr., PE
5b. Business name
(if applicable):
Summe En ineerin Associates, PLLC
y 9 9
5c. Street address:
1342 E. Salisbury Street
5d. City, state, zip:
Asheboro, NC 27203
5e. Telephone no.:
336- 328 -0902
5f. Fax no..
336- 328 -0922
5g. Email address:
mask @asheboro.com
Page 2 of 10

B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID): 7745730560
1b. Site coordinates (in decimal degrees): I Latitude: 35 816595 Longitude: -79.85073
1c. Property size: 67.683 acres
2. Surface Waters
2a. Name of nearest body of water to proposed project: UT to Caraway Creek
2b. Water Quality Classification of nearest receiving water: WS -III
2c. River basin: Yadkin
3. Project Description
3a. Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this
application:
Existing site is partially wooded 8 partially cleared and graded. Surrounding area consists of sparsely located single family residential homes.
Approximately 25 acres have been cleared. grubbed, filled and graded Stream has been impacted by approximately 63 it of pipe and outlet
protection
3b. List the total estimated acreage of ail existing wetlands on the property- 1,496
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property: 5,637
3d. Explain the purpose of the proposed project.
To construct a road/drive access into a proposed industrial park development
3e. Describe the overall project in detail, including the tyype of equipment to be used:
Fill material was transmitted to site from adjacent NCDOT project by tandom axle dump trucks & pans. Soil was spread by D-9 bull dozer &
r,,rA V;br[Vfcrj erenp-ze.tor,, �rn�� ;n,t�tllt°d by trr.ck hoe.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property / © Yes ❑ No ❑ Unknown
project Oncluding all prior phases) in the past? Comments:
4b. If the Corps made the jurisdictional determination, what type
of determination was made? ❑ Preliminary Q Final
4c. If yes, who delineated the jurisdictional areas? Agency /Consultant Company: ECS Carolinas. LLP
Name (if known) Other.
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
Around 2006
5. Project History
5a. Have permits or certifications been requested or obtained for
this project (including all prior phases) in the past? []Yes [o@ No ❑ Unknown
5b. If yes, explain in detail according to "help file" instructions.
S. Future Project Plans
6a. Is this a phased project? © Yes ❑ No
6b If yes, explain.
This project consists of a crossing only A future site is planned but no time frame is known. A preliminary plan has been provided for future work.
Page 3 of 10
PCN Form - Version 1.4 January 2009

C. Proposed Impacts Inventory
1. Impacts Summary
1 a. Which sections were completed below for your project (check all that apply):
❑ Wetlands © Streams — tributaries ❑ Buffers ❑ Open Waters ❑ Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted
2a. I 2b. 2c. 2d. 2e.
Welland impact Type of impact Type of wetland Forested Type of jurisdiction
2f.
Area of
number Corps (404.10) or
Permanent (P) or
impact
DWQ (401, other)
Tem ra
(acres )
W1
Choose one
Choose one
Yes/No
-
W2
Choose one
Choose one
Yes/No
W3
Choose one
Choose one
Yes/No
W4
Choose one
Choose one
Yes/No
W5
Choose one
Choose one
Yes/No
we
Choose one
Choose one
YeslNo
2g. Total Wetland Impacts:
2h Comments:
3. Stream Impacts
If there are perennial or intermittent stream impacts (including temporary impacts) proposed on the site, then complete this
question for all stream sites impacted.
3a.
Stream impact
3b.
Type of impact
3c
Stream name
3d.
Perennial (PER) or
3e.
Type of
3f.
Average
3g.
Impact
number
Permanent (P) or
intermittent (INT)?
jurisdiction
stream
length
Temporary (T)
width
(linear
(feet)
feet)
S1 P
Culvert
UT to Caraway Creek
PER
DW=orps
5
83
S2 T
Stati fzation
UT to Caraway Creek
PER
DWO/Corps
5
15
S3
Choose one
S4
Choose one
S5
Choose one
86 Choose one
3h. Total stream and tributary impacts
98
3i. Comments:
The above items have been installed per attached plan. 83 R permanent impact is pipe, headwall & stabilization 15 ft temp is inlet protection to be
removed down to original stream bed once site is stabilized
Page 4 of 10
PCN Form —Version 1.4 January 2009

4. Open Water Impacts
If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of
the U.S. then individual) list all open water impacts below.
4a. 4b. 4c. 4d 4e.
Open water Name of waterbody
impact number (if applicable) Type of impact Waterbody Area of impact (acres)
Permanent (P) or type
Tem ora
01 Choose one Choose
02 Choose one Choose
03 Choose one Choose
04 Choose one Choose
4f. Total open water impacts
4g. Comments.
5. Pond or Lake Construction
If Pond or lake construction Droposed. then complete the chart below.
5a. 5b. 5c. 5d. 5e.
Pond ID number Proposed use or Wetland Impacts (acres) Stream Impacts (feet) Upland
purpose of pond I I I ,
Flooded I Filled I Excavated I Flooded Filled Excavated
P1 Choose one
P2 Choose one
5f. Total:
5g. Comments:
5h. Is a dam high hazard permit required?
❑ Yes ❑ No If yes, permit ID no:
5i. Expected pond surface area (acres)
5j. Size of pond watershed (acres):
5k Method of construction:
$- Buffer Impacts (for DWQ)
If project will impact a protected riparian buffer, then complete the chart below. If yes, then individually list all buffer impacts
below. If any impacts require mitigation, then You MUST fill out Section D of this form.
6a. Project is in which protected basin? ❑ Neuse ❑ Tar - Pamlico ❑ Catawba [] Randleman ❑ Other:
6b.
Buffer Impact
number —
Permanent (P) or
Temporary T
B1 -
6c.
Reason for impact
6d
Stream name
6e.
Buffer
mitigation
required?
Yes/No
6f.
Zone 1
impact
(square
feet
69.
Zone 2
impact
(square
feet
B2 -
Yes/No
B3 -
Yes/No
84 -
Yes/No
B5
B6
Yes/No
Yes/No
6h. Total Buffer Impacts:
6i. Comments.
Page 5 of 10

D. Impact Justification and Mitigation
1. Avoidance and Minimization
1 a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
Headwall was installed to reduce impact to stream
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques
No digging in the stream was done for pipe placement (after- the -fad) Rip rap placed carefully on existing stone in stream bottom. stream was rocky
2. Compensatory M
Of
2a Does the project require Compensatory Mitigation for
impacts to Waters of the U.S. or Waters of the State?
or Waters of the State
❑ Yes ® No
2b. If yes, mitigation is required by (check all that apply): I ❑ DWQ ❑ Corps
2c. If yes, which mitigation option will be used for this 1:1 Mitigation bank
project? ❑ Payment to in -lieu fee program
❑ Permittee Responsible Mitigation
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank:
Type: Choose one Quantity:
3b. Credits Purchased (attach receipt and letter) Type- Choose one Quantity:
Type: Choose one Quantity:
3c Comments:
4. Complete if Making a Payment to In -lieu Fee Program
4a. Approval letter from in -lieu fee program is attached. ❑ Yes
4b. Stream mitigation requested- linear feet
4c. If using stream mitigation, stream temperature Choose one
4d. Buffer mitigation requested (DWQ only): square feet
4e. Riparian wetland mitigation requested: acres
4f. Non- riparian wetland mitigation requested: acres
4g. Coastal (tidal) wetland mitigation requested: acres
4h. Comments:
S. Complete if Using a Perrnittee Responsible Mitigation Plan
5a. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan.
Page 6 of 10
PCN Form — Version 1.4 January 2009

6. Buffer Mitigation (State Regulated Riparian Buffer Rules) — required by DWQ
6a. Will the project result in an impact within a protected riparian buffer that requires
buffer mitigation?
❑ Yes [] No
6b. If yes, then identify the square feet of impact to each zone of the riparian buffer that requires mitigation Calculate the
amount of mitigation required.
Zone
6c
Reason for impact
6d.
Total impact
Multiplier
6e.
Required mitigation
(square feet)
(square feet)
Zone 1
3 (2 for Catawba)
Zone 2
15
6f. Total buffer mitigation required:
6g. If buffer mitigation is required, discuss what type of mitigation is proposed (e.g., payment to private mitigation bank,
permittee responsible riparian buffer restoration, payment into an approved in -lieu fee fund).
6h. Comments:
Page 7 of 10

Page 8 of 10
PCN Form — Version 14 January 2009
E. Stormwater Management and Diffuse Flow Plan (required by DWQ)
1. Diffuse Flow Plan
1a. Does the project Include or is it adjacent to protected riparian buffers identified
Yes Q No
within one of the NC Riparian Buffer Protection Rules?
1b. If yes, then is a diffuse flow plan included? If no, explain why.
E] Yes j] No
2. Stormwater Management Plan
2a. What is the overall percent imperviousness of this project?
26.45%
2b. Does this project require a Stormwater Management Plan?
1z Yes ❑ No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why.
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan.
Proposed site will be comprised of 150,000 sf of buildings, approx 11.2 ayes of stone storage area for the storage of logs, a parking area and
driveway for car and truck parking Slormwater treatment will consist of a Wet Detention Pond in accordance with BMP A
standards grading plan has
been prepared and was submitted for an erosion control permit and a formal Stormwater Management Plan has been prepared.
2e. Who will be responsible for the review of the Stormwater Management Plan?
DWQ Stormwater
3. Certified Local Government Stormwater Review
3a. In which local government's jurisdiction is this ro'ect?
Randolph County
© Phase II
3b. Which of the following locally - implemented stormwater management programs
❑ NSW
apply (check all that apply):
❑ USMP
D Water Supply Watershed
C] Other:
3c. Has the approved Stormwater Management Plan with proof of approval been
Yes ©No
attached?
4. DWQ Stormwater Pro ram Review
[]Coastal counties
4a. Which of the following state - implemented stormwater management programs apply
11HOW
❑ORW
(check all that apply):
®Session Law 2006 -246
❑Other:
4b. Has the approved Stormwater Management Plan with proof of approval been
Yes No
attached?
S. DWQ 401 Unit Stormwater Review
5a. Does the Stormwater Management Plan meet the appropriate requirements9
© Yes No
5b Have all of the 401 Unit submittal requirements been met?
QX Yes No
Page 8 of 10
PCN Form — Version 14 January 2009

F. Supplementary Information
1. Environmental Documentation (DWO Requirement)
1a. Does the project involve an expenditure of public (federal /state/local) funds or the
use of public (federaUstate) land?
❑ Yes
❑X No
1 b. If you answered "yes" to the above, does the project require preparation of an
environmental document pursuant to the requirements of the National or State
❑ Yes
❑ No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
1c. If you answered "yes" to the above, has the document review been finalized by the
State Clearing House? (If so, attach a copy of the NEPA or SEPA final approval
letter.)
❑ Yes
❑ No
Comments:
2. Violations (DWO Requirement)
2a. Is the site to violation of DWQ Wetland Rules (15A NCAC 2H .0500), Isolated
Wetland Rules (15A NCAC 2H.1300), DWQ Surface Water or Wetland Standards,
®Yes
❑ No
or Riparian Buffer Rules (15A NCAC 2B .0200)?
2b. Is this an after - the -fact permit application?
❑X Yes
❑ No
2c. If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s)-
Permrttee was providing NCDOT with a place for excess fig material to be placed in a very short time frame
3. Cumulative Impacts (DWQ Requirement)
3a. Will this project (based on past and reasonably anticipated future impacts) result in
additional development, which could impact nearby downstream water quality?
❑Yes
©No
3b If you answered "yes" to the above, submit a qualitative or quantitative cumulative impact analysis in accordance with the
most recent DWQ policy. If you answered "no," provide a short narrative description
4. Sewage Disposal (DWO Requirement)
4a. Clearly detail the ultimate treatment methods and disposition (non - discharge or discharge) of wastewater generated from
be In available
A septic sys system usAll installed area of the site that has been located by a sod soenbst since no public sewer is avaiable to the
property at this lime which will be provided by the local health department
Page 9 of 10
PCN Form — Version 1.4 January 2009

5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or
habitat?
❑ Yes ® No
5b Have you checked with the USFWS concerning Endangered Species Act
Pa
Yes © No
5c. If yes, indicate the USFWS Field Office you have contacted.
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
The USFWS websfte Search Engine
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat?
❑Yes ® No
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
NOAH Habitat Conservation Website
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
7a. Will this project occur in or near an area that the state, federal or tribal
governments have designated as having historic or cultural preservation
status (e.g., National Historic Trust designation or properties significant In
Yes Q No
North Carolina history and archaeology)?
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?
NC Listings in the National Register of Historic Places of 11/27/12
B. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA - designated 100 -year floodplain?
❑ Yes ® No
8b. If yes, explain how project meets FEMA requirements.
8c. What source(s) did you use to make the floodplain determination?
Randolph County GIs
Tracy Matson
12-11-2012
Applicant/Agent's Printed Name
Applicant/Agent's Signature
Date
(Agents signature is valid only if an authonzation
letter from the applicant is provided
Page 10 of 10